OPD CONSULTATION FOR NEW AND OLD (SERVICE) PATIENT) 

Check-up of pregnant woman, woman with reproductive health concern, child, or teen, woman or hospital personnel with medical condition who seek (or is brought for) consult for the first time. And Follow-up check-up of pregnant woman, woman with reproductive health concern, child, or teen, woman or hospital

OBSTETRICS

OBSTETRICS

Check-up of pregnant woman, child or teen or hospital personnel with reproductive health concern and medical condition.

 The section of Obstetrics provides prenatal care and instructions to the expectant mothers.  The main objective of  good prenatal care is the delivery of a healthy baby from a healthy mother.

1. Provides prenatal / postnatal care to pregnant and postpartum mother
2. Provides Screening for diseases / Basic Laboratory request.
3. Provides preventive measures / Birth and Emergency Plan thru:
   1. Tetanus Toxoid Immunization
   2. Ferrous Sulfate & Folic Acid Prescription
   3. Vitamin A (as needed)
4. Provides I E C lecture daily (Monday to Friday)
   1. Counsel on Nutrition, Family Planning, Self Care, Breastfeeding & Newborn Screening
   2. Philhealth (OFW Out-Patient Benefit Package)
   3. Policy of Hospital
   4. Rules / SOP procedure to be followed during prenatal care
5. Provides referral to Internist / Surgeon for cases with medical complication. 
6. Answers referral from other institution

Service

 Pre-natal Care

Pre-natal care can start at the earliest time pregnancy is diagnosed or confirmed.

Patients are seen monthly for the first 7 months, then every 2 weeks up to 36 weeks and weekly thereafter.

Tetanus toxoid immunization ( 0.5 cc IM ) is vigorously promoted with the following schedule

First dose                    :               on first visit

Second dose               :               1 month after the first dose

Third dose                  :               6 months after the last dose

Fourth dose                :               1 year after the last dose             

All new patients are screened for high risk pregnancy using a material scoring index

All new patients are required to undergo dental examination.

All new patients are required to listen to the lecture at the OPD . markings are placed on the chart to determine compliance.  Non-compliance face the risk of not being accommodated in subsequent visits.

Post-natal Care

The post-operative cases are instructed to come to the OPD for follow-up by attending physician one week after discharge.

Normal post-partum cases are encouraged to come back for follow-up anytime if she becomes symptomatic and 6 weeks after delivery if asymptomatic, the latter to conveniently coincide with the schedule of infants for 1^st dose of vaccine.

Classification of Patients 

New Cases

They will be given either permanent/regular charts. Permanent or regular charts are given to pregnant patients who come in for prenatal check-ups usually after the 12^th week and before the 36^th week of gestation. Each chart has a corresponding file number which is also reflected in the appointment card issued to the patient.

Follow-up Cases

In case of missed appointment, they are instructed to count 4 days forward from the appointment date and come back on that date. However, if the patients are symptomatic, they can be seen by the team on duty and then scheduled back to their original team.

High Risk Pregnancies

There are cases when there is a factor present in pregnancy which could jeopardize the status or well-being of fetus/mother. Patients are routinely screened for HRP using maternal index.  Laboratory exams are requested to confirm of strengthen diagnosis and ultrasound utilized to do fetal surveillance.  HRP charts are color coded with blue for easier identification and sorting out of cases.

Low Risk Pregnancies

These are cases where there is no risk factor involved which could be jeopardize the well-being of the fetus/mother ( G2-G4 ). They will be attended at SOM by student midwives with the supervision of the instructor. Patients will be transferred to High Risk when there is an occurrence of a risk factor during course of prenatal care.

Consultation Procedure 

1. Registration form is filled up by the patient
2. Donation
3. Patients are weighed and blood pressure taken
4. History and general physical examination of patient are done by medical clerks. Considerable attention is directed towards identifying complicated or high risk pregnancies.  All newly registered pregnant mothers  should be screened according to the maternity high risk index which takes into consideration the patient’s pre-existing health status or medical illness and previous poor pregnancy performance.
5. Patients proceed to dental section for check-up.  All new cases have to pass through the dental section for oral examination. A dental record is made and patients are given chair side lectures on proper dental hygiene.  A notation is placed on the medical chart to signify compliance with dental check-up.
6. Patients should be examined by residents.  High Risk pregnancy cases should be assigned to the more senior resident of the team.

Patients with potential breastfeeding problems are referred to lactation clinic for proper counseling and management.

For patients requiring internal examination, the resident-in-charge accompanies the patient to the internal examination room, performs the examination and notes down his/her findings in the chart.

Patients qualified for tetanus toxoid immunization injection are directed to the OPD staff nurse who administer tetanus toxoid 0.5 cc IM and gives an immunization card to the patient which indicates the number of dose given and the schedule

Admissions

Patients seeking consultation at OPD eventually requiring admission can be classified into emergency ( e.g. severe pre-eclampsia, third trimester bleeding ).  The OPD resident-in-charge prepares the admission order including laboratory results in the OPD.  The OP{D chart is likewise attached to the admission order.

Referrals

1. For HRP cases with medical complications requiring medical consultation, referrals can be addressed to the hospital’s internists.
2. For case falling beyond the realm of his expertise, referrals can be addressed to a general hospital (e.g. JRMMC ). The team consultant should be informed and proper referral/ consultation request made.  It should be recorded in the logbook of referrals in the OPD.
3. Referrals coming from other institution like National Orthopedic Hospital should be examined by the most senior resident of the team and consultant/senior resident notified about the case.

GYNECOLOGY

 GYNECOLOGY

Consultation for woman, child or teen and hospital personnel with reproductive health concern.

1. Provides Basic Comprehensive Services to women of all ages normal and abnormal
2. Provides diagnostic service like pap smear, cervical punch and endometrial biopsy, colposcopy, Gyne ultrasound and Hysterosalphigography.
3. Provides IEC lecture

PEDIATRICS

PEDIATRICS

Consultation of Pediatric patients, children and Infants with medical condition.

 The section of Pediatrics provides full medical care for infants and children from the newborn period to the nineteenth birthday.  It handles acute and chronic problems which may be managed on an ambulatory basis.  It offers a wide range of services geared towards a comprehensive and continuing health care which includes:

Service

Welcome Teens – Adolescent

Under Five Clinic

Well Baby Clinic

It is held daily from1:00 pm to 4:00 pm. It handles babies for periodic check-up, immunization, feeding advice, growth and nutritional monitoring.

Sick Baby Clinic

It is held daily from 8:00 am to 4:00 pm. It handles sick babies who can be treated on an out-patient basis.

Subspecialty Clinic

Cardiology         

                It is held during 2^nd and 4^th Tuesday of the month 10:00 am to 12:00nn.  It handles all walk in cases, diagnosed to have heart problems and follow up cases discharged from the ward.   

Surgical

It is held every Monday from 9:00 am to 11:00 am.  It includes the follow-up post-op cases, referrals for surgical procedures such as incision and drainage of abscess, circumcision or suturing of wound. 

Neonatology

Neo Clinic

        It is held every Tuesday and Thursday 9:00 am to 11:00 am. It handles all babies discharged from the NICU who are required to come back at the OPD after one week and subsequently followed up until they are discharged to the Under 5 clinic.

KMC (KANGAROO-MOTHER CARE) and NICU Clinic

         It is held every Monday , Wednesday, Friday from 9:00 am to 12:00 nn. All babies (2001 of birth ) enrolled at NICU under KMC program are followed up until 1 year of age after which they are discharged to under 5 clinic.

Consultation

Patient seeking consultation are classified whether emergency case or not.  Emergency and serious cases are brought immediately to the emergency room, accompanied by a midwife or nurse.  First aid treatment may be given at the OPD.

For non-emergency cases, the following procedures are followed to maintain orderliness :

1. Patient’s parent/relative fills up pertinent information on pre-registration form.
2. Upon submission of pre-registration form to the OPD staff, a number is attached to the form. First come first serve policy is observed.
3. Patient’s names are called in order of succession and a clinical record/chart is issued.  The OPD Staff member copies the information contained in the pre-registration form into the patient’s chart.
4. A donation is given to the OPD cash clerk who issues an official receipt. The OR number is noted down on the right hand corner of the chart.
5. Five patients are called at a time to go upstairs to the examination area.  The rest are made to stay in the reception/waiting area.
6. Only one person is allowed to accompany patient. While waiting for their turn to be examined by the resident physician, the patient’s weight and temperature are taken. For febrile patients, tepid sponge bath are done by midwives/ student midwives.
7. Patient examined by the resident physician and based on his/her findings, appropriate measures are undertaken. Depending on whether patient is for admission, referral and immunization or for laboratory work up, patient is disposed accordingly.  The date to follow up or return visit is noted down on the appointment card which is returned to the patients’ companion to serve as a reminder.

 Follow-up or Return Visit

1. Provides medical care for infant / children / newborn up to 19^th birthday
2. Handles acute and chronic problems which may be manage on ambulatory basis.
3. Provides wide range of services which includes:
   1. Under Five Clinic – Well & Sick Baby
   2. Subspecialty clinic – Cardio, Surgery, Neonatology and KMC clinic
4. Provides Immunization (Monday – Friday)
5. BCG, DPT, / OPV, Hepa B and Measles
6. Provides IEC lectures daily